Gross motor milestones US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Gross motor milestones. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Gross motor milestones US Medical PG Question 1: A 6-month-old boy is brought to the physician for a well-child examination. The boy was born at term, and the pregnancy was complicated by prolonged labor. There is no family history of any serious illnesses. He can sit upright but needs help to do so and cannot roll over from the prone to the supine position. He can grasp his rattle and can transfer it from one hand to the other. He babbles. He cries if anyone apart from his parents holds him or plays with him. He touches his own reflection in the mirror. Vital signs are within normal limits. He is at the 40th percentile for head circumference, 30th percentile for length, and 40th percentile for weight. Physical examination reveals no abnormalities. Which of the following developmental milestones is delayed in this infant?
- A. Gross motor (Correct Answer)
- B. Fine motor
- C. Social
- D. Language
- E. Cognitive
Gross motor milestones Explanation: ***Gross motor***
- The infant can sit upright with help but **cannot roll over** from prone to supine, which is typically achieved by 4-5 months.
- While he can pull himself to stand (an advanced skill for his age), the inability to roll over indicates a delay in fundamental **gross motor development**.
*Fine motor*
- The infant can grasp his rattle and **transfer it from one hand to the other**, which is an appropriate fine motor skill for a 6-month-old.
- This demonstrates adequate **hand-eye coordination** and manipulation abilities.
*Social*
- The infant **cries if anyone apart from his parents holds or plays with him**, indicating **stranger anxiety**, which is a normal social development milestone for this age.
- This shows appropriate attachment and social discrimination.
*Language*
- The infant **babbles**, which is a typical language milestone for a 6-month-old, indicating early vocalization and speech development.
- This suggests that his pre-linguistic skills are emerging as expected.
*Cognitive*
- The infant **touches his own reflection in the mirror**, which is a normal cognitive behavior for a 6-month-old, showing an interest in faces and self-recognition (even if not full understanding).
- This also encompasses the ability to transfer objects, demonstrating **object permanence** and problem-solving skills.
Gross motor milestones US Medical PG Question 2: A two-year-old female presents to the pediatrician with her mother for a routine well-child visit. Her mother is concerned that the patient is a picky eater and refuses to eat vegetables. She drinks milk with meals and has juice sparingly. She goes to sleep easily at night and usually sleeps for 11-12 hours. The patient has trouble falling asleep for naps but does nap for 1-2 hours a few times per week. She is doing well in daycare and enjoys parallel play with the other children. Her mother reports that she can walk down stairs with both feet on each step. She has a vocabulary of 10-25 words that she uses in the form of one-word commands. She is in the 42nd percentile for height and 48th percentile for weight, which is consistent with her growth curves. On physical exam, she appears well nourished. She can copy a line and throw a ball. She can follow the command to “give me the ball and then close the door.”
This child is meeting her developmental milestones in all but which of the following categories?
- A. Social and receptive language skills
- B. Fine motor skills
- C. This child is developmentally normal
- D. Gross motor skills
- E. Expressive language skills (Correct Answer)
Gross motor milestones Explanation: ***Expressive language skills***
- At two years old, a child should typically have an **expressive vocabulary of 50-200 words** and be putting **two-word sentences** together.
- This child's vocabulary of 10-25 words, used primarily as one-word commands, is significantly below the expected range for her age.
*Social and receptive language skills*
- The child is reported to be doing well in daycare and enjoys **parallel play**, which reflects appropriate **social development** for her age.
- Her ability to follow the two-step command "give me the ball and then close the door" demonstrates intact **receptive language skills**.
*This child is developmentally normal*
- While many areas of her development appear normal, her **expressive language skills** are clearly delayed, indicating that she is not entirely developmentally normal.
- Identifying specific areas of delay is crucial for early intervention.
*Gross motor skills*
- The child's ability to **walk down stairs with both feet on each step** is a normal gross motor milestone for a two-year-old.
- Other gross motor skills like running and kicking a ball are typically present, and there is no information to suggest a deficit.
*Fine motor skills*
- The ability to **copy a line** is an expected fine motor skill for a two-year-old.
- Throwing a ball also involves fine motor coordination and is within the expected range for this age.
Gross motor milestones US Medical PG Question 3: A 15-month-old boy is brought to the pediatrician’s office by his mother due to abnormal muscle tone and an inability to walk. He was able to control his head at 5 months of age, roll at 8 months of age, sit at 11 months of age, and develop hand preference at 13 months of age. On physical exam, he is observed to asymmetrically crawl. He has a velocity-dependent increase in tone and 3+ biceps and patellar reflexes. His startle, asymmetric tonic neck, and Babinski reflexes are present. Which of the following is the most common risk factor for developing this patient’s clinical presentation?
- A. Intrauterine growth restriction
- B. Prematurity (Correct Answer)
- C. Perinatal hypoxic injury
- D. Multiparity
- E. Stroke
Gross motor milestones Explanation: ***Prematurity***
- **Cerebral palsy (CP)** is characterized by **delayed motor milestones**, **abnormal muscle tone (spasticity)**, **hyperreflexia**, and **persistent primitive reflexes** beyond the expected age.
- **Prematurity** (especially birth before 32 weeks' gestation) is the **most common risk factor** for CP overall, accounting for approximately 40-50% of cases.
- The developing brain of premature infants is particularly vulnerable to periventricular leukomalacia (PVL) and intraventricular hemorrhage (IVH), which can lead to various CP subtypes.
- While this patient's **early hand preference** and **asymmetric crawling** suggest hemiplegic CP (often associated with stroke), the question asks for the most common risk factor **epidemiologically**, not the most likely cause in this specific case.
*Intrauterine growth restriction*
- While **IUGR** can be associated with developmental delays and is a risk factor for CP, it is less common than prematurity as the primary risk factor.
- IUGR alone without complications (like prematurity or hypoxia) accounts for a smaller proportion of CP cases.
*Perinatal hypoxic injury*
- **Perinatal hypoxic-ischemic encephalopathy (HIE)** can cause CP, especially severe cases resulting in basal ganglia or watershed area damage.
- However, with modern obstetric monitoring and intervention, severe perinatal hypoxia accounts for only ~10% of CP cases—less common than prematurity.
*Multiparity*
- **Multiparity** (having multiple previous births) is generally not considered a direct or common risk factor for cerebral palsy.
- Any slight associations are typically due to confounding factors like increased risk of preterm birth in subsequent pregnancies, rather than multiparity itself.
*Stroke*
- **Perinatal stroke** can cause CP, typically presenting as **hemiplegic CP** with early hand preference and asymmetric motor findings—features seen in this patient.
- While stroke is a significant cause of hemiplegic CP specifically, it accounts for a smaller proportion of overall CP cases compared to prematurity, which causes various CP subtypes and is more prevalent.
Gross motor milestones US Medical PG Question 4: A 12-month-old boy is brought to the physician for a well-child examination. He was born at 38 weeks' gestation and was 48 cm (19 in) in length and weighed 3061 g (6 lb 12 oz); he is currently 60 cm (24 in) in length and weighs 7,910 g (17 lb 7 oz). He can walk with one hand held and can throw a small ball. He can pick up an object between his thumb and index finger. He can wave 'bye-bye'. He can say 'mama', 'dada' and 'uh-oh'. He cries if left to play with a stranger alone. Physical examination shows no abnormalities. Which of the following is most likely delayed in this child?
- A. Fine motor skills
- B. Language skills
- C. Growth (Correct Answer)
- D. Gross motor skills
- E. Social skills
Gross motor milestones Explanation: ***Growth***
- At 1 year of age, a child's **birth weight should triple**, and their **birth length should increase by 50%**.
- This child's birth weight was 3061 g (6 lb 12 oz), meaning his expected weight at 1 year should be around **9183 g (20 lb 4 oz)**, but he only weighs **7910 g (17 lb 7 oz)**, indicating **inadequate weight gain** (~1273 g below expected).
- This child's birth length was 48 cm (19 in), meaning his expected length at 1 year should be around **72 cm (28 in)**, but he is only **60 cm (24 in)**, indicating **poor linear growth** (12 cm below expected).
- Both **weight-for-age and length-for-age are delayed**, making growth the most likely delayed parameter.
*Fine motor skills*
- The child can **pick up an object between his thumb and index finger**, demonstrating a **pincer grasp**, which is an appropriate fine motor skill for a 12-month-old.
- He can also **throw a small ball**, further indicating age-appropriate fine motor development.
*Language skills*
- The child can say **'mama', 'dada'**, and **'uh-oh'**, which are appropriate first words for a 12-month-old.
- He also **waves 'bye-bye'**, showing appropriate receptive and expressive communication.
*Gross motor skills*
- The child can **walk with one hand held**, which is an expected gross motor milestone for a 12-month-old.
- Many 12-month-olds are just beginning to cruise or take their first independent steps.
*Social skills*
- The child **waves 'bye-bye'** and **cries if left with a stranger alone**, which are age-appropriate demonstrations of **social interaction** and **stranger anxiety**, respectively, for a 12-month-old.
- These behaviors indicate typical social and emotional development.
Gross motor milestones US Medical PG Question 5: A 3-year-old girl is brought to the physician for a well-child examination. She was born at term and has been healthy since. She can climb up and down the stairs and can pedal a tricycle. She has difficulty using a spoon to feed herself but can copy a line. She speaks in 2- to 3-word sentences that can be understood by most people. She is selfish while playing with children her age and throws tantrums quite often. She cannot put on her own shoes and socks. She does not tolerate separation from her parents. She is at 60th percentile for height and weight. Physical examination including neurologic examination reveals no abnormalities. Which of the following is the most appropriate assessment of her development?
- A. Fine motor: Normal | Gross motor: Normal | Language: Delayed | Social skills: Delayed
- B. Fine motor: Delayed | Gross motor: Delayed | Language: Normal | Social skills: Normal
- C. Fine motor: Delayed | Gross motor: Normal | Language: Normal | Social skills: Delayed (Correct Answer)
- D. Fine motor: Normal | Gross motor: Delayed | Language: Normal | Social skills: Delayed
- E. Fine motor: Normal | Gross motor: Delayed | Language: Delayed | Social skills: Normal
Gross motor milestones Explanation: ***Fine motor: Delayed | Gross motor: Normal | Language: Normal | Social skills: Delayed***
- The child can copy a line (expected at 3 years) and climb stairs and pedal a tricycle (expected for a 3-year-old), indicating **normal gross motor skills**. However, difficulty using a spoon and putting on shoes/socks suggests **delayed fine motor skills**.
- Speaking in 2- to 3-word sentences understood by most (expected for 2-3 years) indicates **normal language development**. Being selfish and throwing tantrums (normal for 2-3 years) but not tolerating separation (suggests earlier developmental stage for separation anxiety) point to **delayed social skills**.
*Fine motor: Normal | Gross motor: Normal | Language: Delayed | Social skills: Delayed*
- This option incorrectly assesses fine motor skills as normal when the child struggles with tasks like using a spoon and dressing herself.
- While language and social skills are correctly identified as delayed, the overall assessment of fine motor makes this option incorrect.
*Fine motor: Delayed | Gross motor: Delayed | Language: Normal | Social skills: Normal*
- This option incorrectly assesses gross motor skills as delayed, despite the child's ability to climb stairs and pedal a tricycle, which are age-appropriate.
- It also incorrectly assesses social skills as normal, overlooking the persistent separation anxiety and aggressive social play for her age.
*Fine motor: Normal | Gross motor: Delayed | Language: Normal | Social skills: Delayed*
- This option incorrectly describes fine motor skills as normal and gross motor skills as delayed.
- Her ability to pedal a tricycle and climb stairs indicates age-appropriate gross motor development, while her difficulty with a spoon suggests delayed fine motor skills.
*Fine motor: Normal | Gross motor: Delayed | Language: Delayed | Social skills: Normal*
- This option incorrectly states that both fine motor and gross motor skills are affected and also mischaracterizes social skills as normal.
- The child's language development is within the normal range for a 3-year-old, and her social behavior, particularly the separation anxiety, indicates a delay.
Gross motor milestones US Medical PG Question 6: A 2-year-old girl is brought to the physician by her mother for a well-child examination. She is at the 55th percentile for height and the 40th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. She is able to follow simple commands, such as “close your eyes, then stick out your tongue,” but she is unable to follow 3-step commands. She knows approximately 75 words, and half of her speech is understandable. She can say 2-word phrases, and she is able to name many parts of the body. Assuming normal development, which of the following milestones would be expected in a patient this age?
- A. Hops on one foot
- B. Engages in role-playing
- C. Separates easily from parents
- D. Pedals a tricycle
- E. Builds a tower of 6 cubes (Correct Answer)
Gross motor milestones Explanation: ***Builds a tower of 6 cubes***
- At 2 years old, children typically develop fine motor skills enabling them to stack **6 to 7 cubes** to build a tower, demonstrating good hand-eye coordination.
- This milestone aligns well with the described cognitive development, such as following multi-step commands and early language acquisition.
*Hops on one foot*
- **Hopping on one foot** is a gross motor skill usually achieved later, typically around **4 years of age**.
- A 2-year-old child is more likely to be developing skills like running, jumping with two feet, or walking up and down stairs.
*Engages in role-playing*
- While toddlers engage in **imitative play**, true imaginative **role-playing** with complex scenarios and multiple characters typically develops later, around **3 years of age or older**.
- At 2, play is often more focused on mimicking observed actions.
*Separates easily from parents*
- At 2 years old, many children are still experiencing **separation anxiety**, especially in unfamiliar situations.
- **Easy separation** from parents is a milestone typically achieved later as children develop more independence and social confidence, often closer to 3 or 4 years of age.
*Pedals a tricycle*
- **Pedaling a tricycle** requires coordinated gross motor skills, balance, and cognitive understanding that are typically developed around **3 years of age**.
- A 2-year-old may be able to sit on a tricycle and push with their feet, but not yet pedal efficiently.
Gross motor milestones US Medical PG Question 7: A male child is presented at the pediatric clinic for a well-child visit by his mother who reports previously normal developmental milestones. The child was born at 40 weeks with no complications during pregnancy or birth. The mother notes that the infant is able to sit without support. He is able to feed himself crackers and pureed food. He is constantly shaking his toy teddy bear but is able to stop when the mother says 'no'. Which of the following indicate the most likely language milestone the child presents with?
- A. Two-word combinations
- B. Saying words such as apple and cat, though limited to around 4 different words
- C. Able to say his first and last name
- D. Cooing
- E. Babbling (Correct Answer)
Gross motor milestones Explanation: ***Babbling***
- The developmental milestones described (sitting without support, feeding himself, responding to "no") are consistent with an infant around **6-9 months of age**.
- **Babbling** (e.g., "bababa", "dadada") is the primary language milestone expected at this age, as infants begin to experiment with sounds.
*Two-word combinations*
- This milestone typically emerges around **18-24 months of age**, when infants start to combine words like "more milk" or "mama up."
- The child's overall developmental stage, especially his motor skills, suggests he is significantly younger than the age at which two-word combinations are expected.
*Saying words such as apple and cat, though limited to around 4 different words*
- Saying a few distinct words usually occurs around **12-18 months of age**, after a period of extensive babbling.
- The child's other milestones place him in an earlier developmental period.
*Able to say his first and last name*
- Knowing and saying one's first and last name is a more advanced language and cognitive skill, typically seen in children around **2-3 years of age**.
- This milestone is far beyond the developmental stage indicated by the child's motor and social skills.
*Cooing*
- **Cooing**, characterized by vowel sounds like "ooh" and "aah," is an early vocalization skill typically observed in infants aged **2-4 months**.
- The child's ability to sit unsupported, feed himself, and respond to commands indicates a more advanced developmental stage than cooing.
Gross motor milestones US Medical PG Question 8: A child presents to his pediatrician’s clinic for a routine well visit. He can bend down and stand back up without assistance and walk backward but is not able to run or walk upstairs. He can stack 2 blocks and put the blocks in a cup. He can bring over a book when asked, and he will say “mama” and “dada” to call for his parents, as well as 'book', 'milk', and 'truck'. How old is this child if he is developmentally appropriate for his age?
- A. 18 months
- B. 15 months (Correct Answer)
- C. 9 months
- D. 12 months
- E. 24 months
Gross motor milestones Explanation: ***15 months***
- A 15-month-old child typically **walks independently**, can **stoop and recover**, and **walks backward**.
- They can also use a **cup**, stack **2 blocks**, and have a vocabulary of **4-6 words**, consistent with the child's abilities.
*18 months*
- An 18-month-old child can usually **run well**, **walk up stairs with help**, and build a tower of **3-4 blocks**.
- Their vocabulary is also typically larger, around **10-20 words**.
*9 months*
- A 9-month-old child can usually **sit without support** and **crawl**, but is not yet walking independently.
- They also typically have a vocabulary of only **"mama" and "dada" nonspecifically**.
*12 months*
- A 12-month-old child often takes their **first steps** and may **cruise** while holding onto furniture, but independent walking backward is less common.
- Their manipulative skills are generally less developed, and their vocabulary is often limited to specific "mama" and "dada."
*24 months*
- A 24-month-old (2-year-old) child can typically **run and jump**, **walk up and down stairs independently**, and stack **6-7 blocks**.
- Their vocabulary is significantly larger, often combining **2-3 word phrases**.
Gross motor milestones US Medical PG Question 9: A mother brings her infant for a regular well-child check-up with the pediatrician. During the routine developmental examination, the physician notes that the child is looking at him with his head lifted upwards when he is about to pick up the child from the table. At what age is it common to begin to observe this finding in a child, assuming that the child is developmentally normal?
- A. 2 months
- B. 6 months
- C. 12 months
- D. 9 months
- E. 4 months (Correct Answer)
Gross motor milestones Explanation: ***4 months***
- By **4 months of age**, infants typically develop good **head control** and can hold their head steady while looking around, including when being picked up.
- This signifies strengthening neck muscles and improved coordination, allowing them to **lift their head against gravity** to maintain eye contact with an approaching person.
*2 months*
- At **2 months**, infants can lift their head briefly while on their tummy but generally have limited and **unsteady head control** when pulled to a sitting position or lifted.
- They are unlikely to consistently hold their head up in anticipation of being picked up.
*6 months*
- By **6 months**, infants have excellent head control and can often **sit with support**, and even briefly without it.
- While they can certainly lift their head, this milestone is usually observed earlier, around 4 months.
*12 months*
- At **12 months**, infants are typically **pulling to stand** and cruising, with fully developed head control.
- Observing this specific behavior at 12 months would indicate a significant delay in gross motor development.
*9 months*
- By **9 months**, infants are often crawling, pulling themselves to stand, and have very strong head and neck muscles.
- This developmental stage is well past the initial acquisition of head control needed for the described action.
Gross motor milestones US Medical PG Question 10: An infant boy is brought to the physician for a well-child examination. He was born at term and has been healthy since. He is beginning to crawl but can not yet walk or run. He feeds himself small foods and can bang 2 cubes together. He is just beginning to successfully use a pincer grasp. He has stranger anxiety. He is at the 40th percentile for height and weight. Physical examination shows no abnormalities. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?
- A. Follows one-step commands
- B. Says mama or dada (Correct Answer)
- C. Enjoys peek-a-boo
- D. Gives objects to others
- E. Knows 3–6 words
Gross motor milestones Explanation: ***Says mama or dada***
- The infant is at roughly **9–10 months** based on developmental milestones like crawling, banging cubes, developing pincer grasp, and stranger anxiety.
- At this age, saying **"mama" or "dada" specifically** (not just babbling) is a common and expected **emerging language milestone**.
- This represents a NEW skill being acquired at this developmental stage.
*Follows one-step commands*
- Following one-step commands, especially without gestures, is typically a milestone achieved later, around **12–15 months** of age.
- The infant's current stage of development, particularly concerning language acquisition, indicates they are not yet at this level of comprehension.
*Enjoys peek-a-boo*
- While infants at **9–10 months** do enjoy peek-a-boo, this is not a NEW or emerging skill at this age.
- Peek-a-boo is typically enjoyed starting around **6–9 months** and represents an **already established** skill by this developmental stage.
- The question asks for "additional skills expected" at this age, and "mama/dada" is the emerging milestone, whereas peek-a-boo enjoyment is already well-developed.
*Gives objects to others*
- **Giving objects to others** as a communicative gesture or to share is a more complex social milestone, typically emerging around **12–15 months** of age.
- This action requires a greater understanding of social interaction and reciprocity than what's expected for this infant's current stage.
*Knows 3–6 words*
- Knowing and using **multiple specific words** (3-6 words) is a language milestone typically reached closer to **12–15 months**.
- At 9–10 months, the infant is just beginning to say specific words like "mama" or "dada", indicating an earlier stage of vocabulary development.
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Focuses on gaining head and trunk control against gravity.